Etiology of disparities in birth outcomes: Exploring the chasm between academic literature and health care providers

Academic literature implicates inequity in social determinants of health across the lifespan as the cause of Black-White disparities in birth outcomes in the United States (Lu & Halfon, 2003; Krieger, 2001; Kuzawa & Sweet, 2005; Giscombé & Lobel, 2005). In contrast, health care providers working with expectant mothers engage in practice that targets individual health behaviors, an example of which is the structure and content of prenatal care (Korenbrot, Steinberg, Bender, & Newberry, 2002). This discrepancy between mounting empirical evidence and clinical practice may help to explain the persistence of disparities in birth outcomes. This qualitative study aims to explore the perceptions of maternal health care providers around the root cause(s) of disparities in birth outcomes and efficacy of prenatal care in preventing or ameliorating poor birth outcomes, as well as their suggestions for improving birth outcomes. The purpose of this study is to garner insight into potential avenues for advocacy and policy change around primary prevention of poor birth outcomes and to explore means of closing the gap between research and clinical practice. An on-line survey comprised of open-ended questions will be distributed among clinical staff at a women and children's hospital in Western New York including nurses, nurse practitioners, obstetricians, and neonatologists. In addition, a series of key informant interviews will be conducted with individuals in clinical administrative positions. Content analysis will be employed to extrapolate categories and themes from the data. Results will be presented and opportunities for advocacy and intervention for change will be highlighted.